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Philadelphia - There are multiple steps and mechanisms necessary for carcinogenesis, including multiple genetic alterations that cause an initiation phase, as well as microenvironmental factors that contribute to a promotion phase and a progression phase of a skin cancer.

National report - When a patient suffers damages as a result of care administered by a physician extender and a malpractice suit arises, then the physician as well as the physician extender will likely be sued, says David J. Goldberg, M.D., J.D.

New clinical syndromes

National report - Some of today's newest clinical syndromes highlight the fact that diseases of other organs, including the heart, often manifest on the skin, and these skin findings can offer clues to disease severity.

Oral isotretinoin, hormonal agents and photodynamic therapy all are effective modalities for acne treatment that work through the sebaceous gland - yet caveats apply to each.

Noninvasive skin cancer treatment can be an attractive option for patients, especially in this age of new techniques and pharmaceutical discovery. But with new and exciting advancements often come new and complex questions. Dermatology Times asked Ronald Moy, M.D., a Los Angeles Mohs surgeon and former professor at the University of California, Los Angeles, and Marc D. Brown, M.D., a Mohs surgeon and professor of dermatology and otolaryngology at the University of Rochester Medical School, Rochester, N.Y., to discuss noninvasive skin cancer treatments.

West Haven, Conn. - The kidney cancer drug Nexavar has been granted fast track designation by the Food and Drug Administration for treatment of advanced melanoma, manufacturer Bayer Pharmaceuticals announced.

Scottsdale, Ariz. - For many dermatologists, the new iPLEDGE registry has brought hassles and headaches, but there are plenty of benefits to be considered that could ultimately make the initial ordeal worthwhile, said Hilary Baldwin, M.D., at a recent meeting of the Skin Disease Education Foundation.

Be aware, be prepared

New Orleans - A disaster of Hurricane Katrina's proportions could strike virtually anyone anywhere, say dermatologists still struggling with the aftermath of the storm that ravaged this city in August 2005.

It's the job of sales representatives to sell their company's products. But with many dermatologists reporting six to eight week wait times for patients to get in for appointments, how do pharmaceutical sales people get their feet in the door to make their presentations?

The proposed change would make the practice expense methodology more transparent and easier to understand, would make it consistent across procedures, and would utilize data that has been collected by specialty societies.

In the past, I've used this space to rally for volunteerism/charitable endeavors and discuss outstanding services performed by those in dermatology. My sense has been that, while I'm not entirely "preaching to the choir," I am addressing a group of specialists, my fellow dermatologists, of whom many graciously give of their time in charitable medical and nonmedical ways.

Results from one-year of follow-up in a phase 3 trial investigating infliximab (Remicade, Centocor) for the treatment of moderate to severe psoriasis demonstrate that the dramatic responses achieved rapidly after induction therapy are sustained with maintenance therapy in the majority of patients and without the emergence of new safety concerns, reported Alan Menter, M.D., at Academy '06.

A network of teledermatology links throughout Alaska is providing cost-effective, timely access to dermatologic care for indigenous peoples in the nation's most underserved and sprawling state, its designer reports. Teledermatology programs organized by the Alaska Tribal Health System (ATHS) serve approximately 50,000 patients scattered throughout the state, reports John H. Bocachica, M.D., F.A.A.D., chief, dermatology and teledermatology at the Alaska Native Medical Center (ANMC) in Anchorage.

Dermatologists in outpatient practices should maintain an index of suspicion for infections caused by community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) and recognize the need to prescribe alternatives to the usual antibiotics that can be relied upon to effectively treat the majority of skin and skin structure infections they see, says Kenneth J. Tomecki, M.D., department of dermatology, The Cleveland Clinic Foundation.

The very recent approval of the quadrivalent human papilloma virus (HPV) virus-like particle vaccine (Gardasil) is the biggest breakthrough in medicine in the 21st century so far because its prevents infection with the virus that is the second leading cause of cancer deaths in women worldwide, says Stephen K. Tyring, M.D., Ph.D.

The most common cause of primary septal panniculitis is erythema nodosum. The clinical and microscopic features causing this disease are well known to the experienced dermatologist. The most common etiologic agents in erythema nodosum include infections (e.g. group A beta hemolytic strep, deep fungal and viral), drugs (e.g. oral contraceptives and sulfonamides), inflammatory bowel disease, sarcoidosis, pregnancy and malignancy.Dr. Robinson-Bostom says that, "We have found new associations concerning the etiologies in erythema nodosum. These include hepatitis C and HIV infections, all trans retinoic acid, echinacea herbal therapy, celiac disease, as well as carcinoid syndrome."

While biologic drugs may not provide a first-line treatment for psoriasis, dermatologists are reaching for them somewhat more readily, an expert says.

San Diego, the host city of this year's AAD summer meeting, July 26-30,offers attendees an ideal climate for enjoying the great outdoors. Take some time to explore the surroundings with a run on the beach, a bike ride on a scenic trail, or for the more adventurous spirit, rock climbing in the backcountry.

The following links feature products and services from manufacturers who are exhibiting at the 2006 Summer AAD meeting in San Diego. Exhibit Hall booth numbers have been included so that you can find items and exhibits of particular interest to you.

National report - Over recent years, the combining of various laser and other light-based therapies with existing topical treatments and systemics has become a trend in dermatologic practices - and one that's likely to continue.

Scottsdale, Ariz. - Although it remains the gold standard for skin rejuvenation, CO2 laser resurfacing is paradoxically losing favor due to drawbacks ranging from the risk of complications to increasing patient reluctance over downtime and concerns about the complications.

New York - Dermatologists are finding a variety of ways of combining topical therapies with new technologies to get better results in the treatment of numerous skin conditions, such as wrinkles and other sun damage.

San Francisco - Coleman Jacobson, M.D., received the American Academy of Dermatology's highest award, the Gold Medal Award, at the Academy's 64th Annual Meeting here in March.

National report - With demand for dermatologists' services outstripping supply in many areas of the country, sources say universities and other healthcare organizations are adding residency slots and pursuing innovative ideas to address patient access problems.